Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06001969A | IN |
NPI | 1013182948 |
---|---|
Provider Name | Mrs. Robin Lynn Krassow |
First Address | Trail Creek, IN 46360-5709 |
Second Address | Trail Creek, IN 46360-5709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200675870A | FIRST STEPS (01) | IN |